Registration (Nursery)

Kid's Ministry Registration Form (Nursery)

Child's First Name

Name Goes By

Child's Last Name

List any known allergies / food allergies your child may have:

List any medical conditions or physical limitations your child may have:

Birthday

Age

Gender

Child's Address

City

Zip Code

Mother/Guardian Name

Email Address

Mother/Guardian Phone #

Father/Guardian Name

Email Address

Father/Guardian Phone #

Provide the first and last name of other people who have your permission to pick up your child (this includes older siblings):

Are there any learning or educational concerns that would help us serve your child better?

I give permission for my child to be photographed for possible use in church media and printed materials.

Please do not photograph my child.

By typing your name you are electronically signing this form.

Date: